The story of living in spite of melanoma, metastasis, vaccines, anti-PD-1, lung removal, and stereotactic radiation. The story of life with family and friends. {Posts under ~ Sew Chaotically, Travel Chaotically, and Chaotic Cookery also housed within! A girl's gotta have fun!}

About Me

Who am I? That is a question the rest of you could probably answer better than I. I am a wife, mother, daughter, sister, friend, pediatric nurse practitioner, cook, teacher, gardener, lover of words and music, occasional seamstress, and homemaker. I do have a couple of talents of questionable merit: I can create a decent meal in less than 30 minutes. I can feed and/or soothe almost any baby. And I can remember practically any song I've ever heard. For the rest, I'd rather those who know me decide.

Saturday, March 25, 2017

Circulating DNA predicts response to anti-PD1

One more thing I have been yelling about for years!!! Medicine now has the technology to determine all sorts of things via a simple blood draw. Circulating tiny bits of tumor DNA floating through our blood can tell docs what type of tumor we have, predict response to a given treatment and let us know how the treatment is working. Here is a link to years of posts: Circulating DNA in melanoma treatment from 2014 til now!!

Programmed
death 1 (PD1) inhibitors are now a foundation of medical management
of metastatic melanoma. This study sought to determine whether
circulating tumour DNA (ctDNA) provides useful early response and
prognostic information.

We
evaluated the relationship between pre-treatment and early on
treatment ctDNA and outcome in melanoma patients treated with PD1
inhibitors alone or in combination with ipilimumab.

ctDNA
was detected in 40/76 patients (53%) at baseline, and correlated with
stage, LDH levels, disease volume and ECOG performance. RECIST
response was 72% (26/36) in Group A (undetectable ctDNA at baseline),
77% (17/22) in Group B (elevated ctDNA at baseline but undetectable
within 12 weeks of therapy) and 6% (1/18) in Group C (elevated ctDNA
at baseline and remained elevated during treatment). The median PFS
was not reached in groups A and B and was 2.7 months for Group C. The
median OS was not reached for Groups A and B and was 9.2 months for
Group C . The poor outcome measures associated with Group C remained
significant in multivariate analysis adjusted for LDH, performance
status, tumour stage and disease volume. The predictive value for
ctDNA for response was confirmed in a separate validation cohort.

Longitudinal
assessment of ctDNA in metastatic melanoma patients receiving
treatment with PD1 inhibitors is an accurate predictor of tumour
response, PFS and OS. Patients who had a persistently elevated ctDNA
on therapy had a poor prognosis, and this may guide combination and
sequencing of subsequent therapies.

Clearly, per the results of this study, patients did best when their circulating tumor DNA became undetectable under treatment. Conversely, as one might suspect, when ctDNA remained elevated despite treatment, folks did less well...even when researchers controlled for known prognostic indicators like LDH, disease volume, etc.

We KNOW these facts. We HAVE the technical ability. WHY is this not standard of care??